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Date��7 <br />Appiicalion For <br />PUBLIC ViIORKS I�ERMIi�' <br />Print or Type Only <br />Mailing <br />Describe ?raposcd Work <br />Prolect Address (il known) <br />City .. 7�P <br />Zip <br />vuoec worhs rurmi� . �� �.�( (/�G <br />9119. DePI. � Q��f-- <br />Pu�lic Worts Fea S <br />To:nl Foe <br />Lasf Appl. Fe¢ PaiC � � <br />e0ia�oao�a 5 �� �— -- <br />Att�ch four (4) copies of plans lo� proposed v�ork • Draw tn scale and nole the foll�wing as applicable: <br />• Property Linos .• Centerline ot sireel <br />• Outline a�d dimensions of all existing and • Indicate Nor�h <br />proposed snuctures on ihe lo� • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenls <br />ne <br />PERtAIT CONDITIONS <br />1. All c�lls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall 6e performec �� accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specilica�ions. <br />3. Call Location UndergrounA Service 48 hrs. before you dig. TOLL FREE NUMBER 1•A00•424-5555. <br />FINAL INSPECTION <br />Approved as Consiructed <br />everett PUBLIC WOPKS �EPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-�C5- $$�� <br />AC;KNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />The undersigneJ owneqapplicant hereby agrees lo hold and save harm- <br />less the City of Everett Irom any and all claims lor damages, cosls, <br />expenses, or causes ol action that may arise because of installation <br />� end maintenance of ihe improvement or other right-ol-way use hereto <br />�-�pplied for and furth�r ugrees to remove same upon notice Irom the <br />�ate �T�and to replace pub)ic�ropertxdamaged ��reby. <br />Date <br />Sit,�nature of APPlica� � """' <br />WORK AUTHOBIZ D 8Y THIS PERMIT MUSf tlE STARTED WITHIN <br />180 DAYS�4F DATE PERMIT IS ISSUED A�VD ?HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. iHIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON A.NY STOPPAGE OF WORK ON THIS <br />P(iOJECT OVER 90 DAYS DURATION. <br />